A child is the future of a family, and it is the wish of every family to have a healthy and smart child, but for various reasons, malformations and defects in newborns still occur. According to statistics, the prevalence of congenital heart disease is about 7 per 1,000 births, which means that there are 7 children with congenital heart disease in every 1,000 births. However, there are still many parents who miss the opportunity to treat or even cure the disease because they are not aware of it.
Q: It is every family’s good wish to have a healthy and smart child, but due to various reasons, malformations and defects in newborns still occur from time to time. Can congenital heart disease be understood as congenital heart malformation?
A: Yes. Congenital heart disease is a type of heart disease that results from a disorder of heart development during fetal life. Unlike acquired heart disease, which occurs after birth, congenital heart disease is brought from the mother’s womb and often has varying degrees of structural heart abnormalities, such as atrial septal defect, ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot. Currently, the prevalence of congenital heart disease is about 7 per 1,000 births, which means that there are 7 children with congenital heart disease in every 1,000 births, which is not a small number.
Q: Having a child with heart disease at birth is a big shock to first-time parents. What are the main factors that trigger congenital heart disease at present? Is there any way to prevent it?
A: The causes of congenital heart disease are complex, and after years of scientific research, there is now a lot of knowledge about the causes of congenital heart disease. The main causes can be divided into environmental factors and genetic factors.
1.Environmental factors
(1) Viral infection during pregnancy, especially in the first three months of pregnancy, if a pregnant woman has a viral infection, such as influenza virus, rubella virus, coxsackie virus, etc., the incidence of congenital heart disease is higher in her born babies.
(2) Consumption of water and food contaminated with chemicals, alcohol abuse, etc.
(3) Pregnant women with diabetes mellitus.
(4) Exposure to excessive radiation.
(5) application of certain drugs with teratogenic effects in early pregnancy.
(6) Older pregnant women, especially those who are close to menopause in age, are prone to precocious heart disease in pregnant children.
2, genetic factors
About 10% of the incidence of congenital heart disease. Congenital heart disease has a certain degree of family tendency, can be caused by genetic genes, chromosomal aberrations. Genetic mutations account for about 1-2%, such as Marfan’s syndrome; chromosomal aberrations account for 4-5%, such as 21-3 body syndrome (Down’s syndrome). If a parent has congenital heart disease or has a child with congenital heart disease, there is a higher chance of congenital heart disease in the fetus of another pregnancy.
In fact the occurrence of congenital heart disease is often the result of a combination of factors in many cases. In other words, when a pregnant woman with a certain genetic predisposition to congenital heart disease encounters environmental factors such as infection, radiation and drugs in the early stages of pregnancy, the likelihood of her pregnant child developing congenital heart disease increases significantly.
Q: Strengthening health care during pregnancy, especially actively preventing viral diseases such as rubella and influenza in early pregnancy, and paying attention to avoiding all factors related to the development of congenital heart disease are crucial to the prevention of congenital heart disease. Due to the different parts of cardiovascular malformation, the symptoms and degree of congenital heart disease also vary, so what are the main types of congenital heart disease?
A: There are many classifications of congenital heart disease. Clinically, congenital heart disease is mainly divided into two categories according to the presence or absence of cyanosis, namely non-cyanotic congenital heart disease and cyanotic congenital heart disease. Non-cyanotic precardiac disease is mainly left-to-right shunt precardiac disease, accounting for most of the precardiac disease, the main diseases are arteriovenous ductus arteriosus, atrial septal defect, ventricular septal defect, etc.; cyanotic precardiac disease is mostly complex precardiac disease, the main diseases are tetralogy of Fallot (i.e. right-to-left shunt exists in the heart), complete large artery misalignment (intracardiac arterial and venous blood mixing), etc. Clinically, large vessel malformations in the thoracic cavity such as patent ductus arteriosus and aortic constriction are also commonly referred to as precordial disease.
Q: What are the main manifestations of a child with precordial disease? As a parent, how can we find out if our child has congenital heart disease in time?
A: The manifestations of a child with congenital heart disease are related to the type and severity of the heart disease. The clinical manifestations of different types of congenital heart disease can vary greatly.
1, cyanotic precocious heart disease because the child’s lips and nails of the mouth and toes cyanosis, crying after the cyanosis aggravated, easy to be detected by parents early. If cyanosis appears after birth, it is often a complex congenital heart disease, such as tricuspid atresia, pulmonary atresia, aortic dislocation or severe Farrow’s triad. If cyanosis appears a few months after birth, it is most likely to be tetralogy of Fallot.
2, non-cyanotic precocious heart disease, early often not easily recognized by parents, many defects are very small left-to-right shunt type precocious heart disease, such as small ventricular defect, small arterial duct end closure, hole II type atrial septal defect, as well as mild pulmonary stenosis, aortic bivalve malformation, etc., because of the light impact on cardiopulmonary function, the child is apparently the same as normal children, good growth and development, strenuous activity also does not wheeze, easy to be ignored by parents, often in They are often detected during physical examinations or by hearing heart murmurs when looking at other diseases. However, in this category of seriously ill patients, the presence of a large left-to-right shunt can seriously affect cardiopulmonary function, often showing shortness of breath while breastfeeding, sweating, purple around the mouth, wasting, and delayed growth and development, and some children often experience pneumonia and heart failure, requiring repeated hospitalization. Moreover, these patients are often combined with pulmonary hypertension, non-cyanotic precocious disease, if not diagnosed in a timely manner to give surgery, will form irreversible pulmonary hypertension, to a few years old, teenage or adult gradually appear cyanosis (or Eisenmenger syndrome), then will lose the opportunity to surgical treatment.
Therefore, in general, the common symptoms of severe precordial disease are.
1, “repeated pneumonia”: refers to more than four or five times a year “pneumonia”, sometimes combined with heart failure.
2, “feeding difficulties”: refers to feeding the child to eat and stop, each time it takes more than half an hour, crying hoarsely.
3, poor mobility: compared with children of the same age, the child is often not moving well, moving then wheezing, sweating profusely.
4, growth retardation: children with cyanosis are significantly shorter, lighter and thinner than children of the same age.
Children with cyanotic heart disease often have blue lips, skin of the extremities, white of the eyes, fingers and toes like drums and hammers (pestle and mortar), children with Tetralogy of Fallot, like to squat after activity, some may have hypoxic episodes, making the cyanosis worse, and even coma and cramps. Some children die due to severe hypoxic attacks.
Q: In fact, regardless of whether the child’s symptoms and degree are mild or severe, families with children with preexisting heart disease are worried about the prognosis of their children.
A: This concern is justified. Congenital heart disease is a group of diseases that seriously endanger the physical and mental health of children. The main symptoms are feeding difficulties, recurrent respiratory infections, and growth retardation during infancy due to severe hemodynamic abnormalities. The incidence of bacterial endocarditis is many times higher than normal.
Q: It seems that the prognosis of patients with precordial disease is not optimistic. Director Liu, in this case, is early diagnosis and early treatment particularly important?
A: Yes. It is very important to detect precocious heart disease as early as possible, and it is best to make a correct diagnosis at the neonatal stage so that a correct treatment plan can be formulated as early as possible and a reasonable timing for surgery can be determined, to do this we must start from two aspects.
1, one is that parents should be alert to precardiac disease, once they find abnormal heartbeat, purple skin, susceptibility to pneumonia, growth retardation and other abnormalities in the child, they should promptly choose a hospital with a cardiology specialty, especially a children’s specialty hospital for consultation.
2, secondly, clinicians, especially obstetricians, neonatologists and clinical front-line physicians should be good at detecting precardiac disease, we believe that a comprehensive physical examination soon after birth will greatly facilitate the early detection of precardiac disease. Many critical precocious heart diseases are often saved in time because of early detection. It is actually not difficult to detect congenital heart disease, the majority of congenital heart disease have heart murmurs, as long as careful auscultation is easy to find this abnormal signs, which is often the first evidence of clinicians to detect congenital heart disease, and then do further tests, such as electrocardiogram, front and side x-ray of the heart, cardiac ultrasound and other tests, you can make a more correct diagnosis of common congenital heart disease. Of course, complex congenital heart disease also needs to go to a hospital with better precocious heart surgery for further examination, and some children still need to undergo cardiac catheterization and cardiovascular angiography to make a clear diagnosis.
In conclusion, if your child is found to have congenital heart disease or suspected heart disease, you should go to a cardiac specialist hospital for consultation. Pediatric cardiology and surgery is a specialty that specializes in the diagnosis and treatment of congenital and acquired heart disease in children and adolescents, and can not only diagnose heart disorders, but also guide your treatment, including the best timing and choice of surgical procedures.
Q: It seems that early detection of congenital heart disease and the development of a proper and effective treatment plan are crucial to the treatment of congenital heart disease, which is also a common concern for patients and their families. What treatments are currently available for precardiac disease and how should patients choose them?
A: There are three main types of treatment for precardiac disease: surgical treatment, interventional treatment and conservative observation. The vast majority of patients with precardiac disease require surgical treatment (including palliative surgery and radical surgery); a small percentage of patients can be treated with interventional therapy; and only a small percentage of cases eventually heal naturally after conservative observation. The rapid development of cardiac surgery techniques has made it possible to operate on precardiac disease entirely from the point of view of the child’s condition, without special consideration of the child’s age. This is a major breakthrough in the field of precardiac surgery, and I would like to remind the audience, especially the parents of children with precardiac disease, that the timing of surgery as suggested in some textbooks has lagged behind, and some general hospitals, because of the limitations of surgical instruments and monitoring conditions, are temporarily difficult to reach the level of considering only the condition of the child without considering the age of the child. We hope that the parents of the child will maintain direct contact with the relevant clinicians and especially with the clinical pediatric cardiac surgeons so as not to delay the best timing of surgery for the child.
Q: Which patients can be conservatively observed?
A: At present, most of the patients with precardiac disease can be operated at a younger age (within 2 years old or even in the neonatal period), and a few cases can be treated by conservative observation.
1, those with small diameter and no tendency of pulmonary hypertension secondary to hole atrial defect can be observed until the age of 3-5 years before surgery.
2.Membrane ventricular septal defect less than 4 mm in diameter has a mild effect on cardiac function and has the possibility of automatic closure, so it can also be observed until 3-5 years of age, and if the ventricular defect still fails to close then surgery should be considered. Since small ventricular defects have the potential to induce bacterial endocarditis, and the safety of surgical procedures is currently very high, longer waiting time is not recommended.
3, aortic valve with transvalvular pressure difference less than 40 mmHg and pulmonary valve stenosis less than 60 mmHg. The premise of conservative treatment in these cases is that the heart must be examined by ultrasound more than twice in a hospital with a high level of precordial surgery treatment to avoid misdiagnosis and delayed treatment.
Q: It seems that the choice of conservative observation must be made under the guidance of a cardiologist, and parents should not make arbitrary decisions because the child’s symptoms are mild, so as not to delay the disease, and the vast majority of patients with precordial disease need to undergo surgical treatment. How should the timing of surgery be chosen for patients with precardiac disease?
A: Choosing the right time for surgery is the key to successful surgery and a good prognosis. Currently, there are several major factors in determining the timing of surgery.
1, the pathological characteristics of the precordial disease itself and the degree of impact on hemodynamics: Generally speaking, the more complex the malformation, the greater the impact on hemodynamics, the more early surgery should be treated.
2, the progression of secondary pathological changes: left-to-right shunt type of precordial disease, should strive for surgical correction before the occurrence of pulmonary vascular obstructive changes. Cyanotic, obstructive preconditioning should strive to operate before the occurrence of severe myocardial hypertrophy and fibrous degeneration.
3, the comprehensive level of the operating hospital: including the level of diagnosis, anesthesia, extracorporeal circulation, surgical experience, the level of perioperative monitoring and the relevant hardware conditions that the hospital has.
Q: What are the main surgical methods in clinical practice?
A: The surgical methods for precardiac disease are mainly determined by the type of heart malformation and the degree of pathophysiological changes, etc. The surgical methods can be divided into three categories: radical surgery, palliative surgery and heart transplantation.
1. Radical surgery can be performed to correct anatomical or hemodynamic deformities and restore them to a normal state.
2, palliative surgery, can only play a role in improving the symptoms but can not play a radical effect, mainly used for complex precordial diseases that do not yet have a cure, such as modified Glenn, Fontan surgery, or as a preparatory surgery to create the conditions for radical surgery, such as body-lung bypass, central palliative surgery.
3.Heart transplantation, mainly used for terminal heart disease and complex precordial disease that cannot be treated by current surgical methods.
Q: Is it possible to do radical surgery as long as one has the physical and economic conditions?
A: Due to the rapid development of cardiovascular surgery, the surgical methods are improving, medical equipment is perfecting, and the scope of indications for surgery is expanding, almost all congenital heart diseases can be surgically corrected. According to the current level of surgical technology at home and abroad, the current indications for surgery are usually.
1, all left-to-right shunt type of congenital heart disease (arteriovenous ductus arteriosus, atrioventricular defect, ventricular defect, etc.) should be operated as early as possible once moderate or above pulmonary hypertension occurs, regardless of age, and if the condition requires, surgery can also be performed in the neonatal period.
2.Patients with simple ductus arteriosus, atrial defect, ventricular defect, etc. without pulmonary hypertension can wait until the age of 3-5 years for surgery.
3, patients with tetralogy of Fallot were considered appropriate to be operated at the age of 3-5 years, but in recent years, clinical and basic research has shown that the best time to operate is within 2 years of age, especially for those with recurrent hypoxia, surgery can be performed within 1 year of age or even in the neonatal period.
4, patients with large-vessel dislocation with intact ventricular septum, if there is no pulmonary stenosis, must be operated within 4 weeks after birth; patients with pulmonary atresia with intact atrioventricular septum, it is also appropriate to operate in the neonatal period.
5, need to use the same kind of flap tube to perform corrective surgery, domestic surgery is recommended at the age of 3-4 years or more; but in recent years, it is considered more favorable to operate in infancy.
6, the complete atrioventricular channel should be operated within 2 years of age.
7, the timing of surgery for other rare malformations should be determined by pediatric cardiac surgeons depending on the specific condition.
Q: What is the success rate and near and long-term efficacy of surgery for precordial disease in China? This is the most important concern for patients and families.
A: The development of cardiac surgery must be decided by the comprehensive level of the surgical unit itself, and the success rate of surgery varies slightly from hospital to hospital. For our hospital, the overall success rate reached more than 98.5%, the success rate of complex precardiac disease and infant surgery are significantly improved, in the domestic more advanced level. At the same time, Nanjing Children’s Hospital is one of the few hospitals in China that can no longer worry about the problem of small age and low weight of children based entirely on the condition of the sick child. At present, the overall success rate of surgery for precardiac disease in China is about 96-98%. If surgery is performed before serious complications such as severe pulmonary hypertension and cerebral embolism occur, the long-term results for more than 95% of the children are ideal.
Q: It is amazing how high the technology of current cardiac surgery is and how fast it is developing! At present, early treatment and radical cure of precardiac disease is a trend in the development of cardiac surgery, why is that?
A: Because precordial disease from the fetal period that began to produce a certain impact on the body, after birth, regardless of the severity of the disease, will have a more or less important organs such as heart and lungs, especially in children with severe disease, in infancy and early childhood on the growth and development of a great impact. In the early years, due to the low success rate of surgery, it was necessary to wait until a certain age to operate, but very unfortunately, during the waiting process, some of the children died due to aggravation and some formed irreversible damage, and even if they waited until an older age to operate, most of them would still have certain effects in the long term after surgery. Therefore, we emphasize that children with precardiac disease should be operated in infancy and early childhood as much as possible.
Q: We know that surgery for precardiac disease is a very demanding operation in terms of technical requirements and equipment.
A: The performance of cardiac surgery is largely dependent on the support of high-tech instruments and equipment.
1, all cardiac surgery must be performed under general anesthesia with tracheal intubation, which requires an anesthesia machine with excellent performance to operate, and the safety performance of anesthesia has been very high at present.
2, except for arterial catheterization ligation, other cardiac surgery need to be supported by extracorporeal circulation, that is, the machine instead of heart and lung work (artificial heart and lung machine), the large blood vessels in and out of the heart will be inserted into the tube to draw venous blood outside the body, through the artificial lung for gas exchange, expel carbon dioxide, inhalation of oxygen, so that venous blood into arterial blood, and then pump pressure to inject blood into the body to maintain the blood supply of the organs With this guarantee, we can stop the heart and dissect it for surgery. In recent years, due to the obvious improvement of extracorporeal circulation technology, we are able to perform very complicated heart surgery as well as the smallest heart surgery for newborns.
3. A set of cardiac, blood gas and blood biochemical monitoring equipment and equipment to perform mechanical ventilation must be available during and after surgery to ensure that the child passes through the dangerous period.
Q: We know that there are many units that can carry out surgery for precocious heart disease, but it is still many pediatric precocious surgery treatment centers that really carry out a larger number and higher level.
A: I think the problem is multifaceted, the advantages of the pediatric precordial surgery treatment center are mainly manifested in.
1, preoperative diagnosis in line with a very high rate, as you know, a higher preoperative diagnosis accuracy is the first guarantee of successful surgery.
2, fine surgical operation, children, especially infants and young children newborn heart as small as pigeon egg, as tender as tofu, must use special surgical instruments, fine dexterity to minimize the damage to the heart, so as to lay the foundation for smooth recovery after surgery
3.Anesthesia and extracorporeal circulation techniques different from those used in adult cardiac treatment, which are more important especially in small age and low weight children.
4.Unique monitoring technology, this is our advantage, as we know, children can not express their feelings, need our monitoring nurses to constantly observe the changes in the condition, especially the management of the respiratory tract, a small amount of respiratory secretions for adults do not need to make a fuss, but for infants and children may lead to immediate death by asphyxia.
5.Arterial and venous puncture techniques.
6, psychological guidance and psychotherapy for children. All these combined factors constitute the unique technical advantages of the pediatric precordial surgery treatment center. We believe that the surgical technique of precordial surgery plays only half of the role in the survival rate of children, while good anesthesia and extracorporeal circulation techniques and monitoring techniques are one of the very, very important factors for the success of surgery.
Q: Heart surgery is a very complicated operation, which is a big test for the child and the family, so what are the issues that children with precordial disease need to pay attention to before surgery?
A: Since children with left-to-right shunt type of precordial disease are prone to respiratory infections, heart failure and poor growth, before surgery, children should first pay attention to seasonal changes and keep warm to reduce the chance of respiratory infections, and once respiratory infections occur, they should go to the local hospital in time; at the same time, they should pay attention to strengthening nutrition and not to develop the habit of picky eating. Due to the physiological defects of the affected children, their growth and development are slower than normal children, and parents often hope to give the affected children more acquired supplements and provide various high-protein foods. In fact, it is important for children with prediabetes to have a balanced diet because their heart load capacity is lower than that of the general population, so special attention should be paid to the absorption capacity. Children with poor cardiac function should take cardiac stimulants under the guidance of doctors and also pay attention to consume a low-salt diet; children with cyanotic precocious heart disease are at risk of complicating cerebrovascular embolism due to the high viscosity of their blood, so they should be encouraged to drink more water to reduce blood viscosity.
Q: What are the issues that need to be taken care of when the child goes home after surgery? How should the parents take care of the child?
A: When a child with precordial disease is discharged from the hospital after surgery, it does not mean that all problems are solved and the disease is completely recovered. Because of the deformity of the heart itself and the trauma of the surgery, it takes a long time for the heart function to recover after the surgery, so parents must have patience. Therefore, (full screen caption Post-operative children with precordial disease need to pay attention to:) In the first 3 months after surgery must pay attention to a regular life, pay attention to rest, do not watch too much TV and play, to ensure enough sleep, 1-3 weeks after surgery is the high incidence of secondary residual fistula, during which special attention should be paid not to let the child do too strenuous exercise; keep the room appropriate temperature and humidity, keep the air circulation. Within 3 months of discharge, it is not advisable to go to public places to prevent respiratory and skin infections; pay attention to dietary hygiene, patients should pay attention to supplemental nutrition after discharge, and there are generally no special contraindications to the type of diet, but foods with high nutritional value and easy to digest should be consumed, such as lean meat, fish, eggs, fruits and vegetables. It is advisable to eat less and more meals, the amount of food should not be too full, not to mention overeating, so as not to increase the burden on the heart; some children with precordial disease still need to take a longer period of cardiac diuretic drugs, can not stop or add drugs without authorization, in order to avoid the risk. Once the condition is aggravated, you must contact the operating hospital immediately to prevent accidents.
Q: In general, how often do patients need to go to the hospital for follow-up examinations after surgery?
A: Children with precordial disease need to continue to follow up after surgery. Our principle is: 1-3 months after surgery, the first follow-up, and six months after surgery, the second follow-up, depending on the patient’s condition at the time of discharge; those with incomplete heart function at the time of discharge need to follow up earlier; after the first review, echocardiography shows satisfactory correction of deformity and good heart function, even if there are still changes in cardiac X-ray and ECG, they can The follow-up period will be gradually extended until the ECG, ultrasound and cardiac X-ray are normal, and the follow-up can be stopped.
Q: With the continuous improvement of medical level in the world and in China, the situation of surgical and non-surgical treatment of congenital heart disease is encouraging. New advances in the current surgical treatment of anterior congenital heart disease and the outlook on the development of congenital surgery in the 21st century.
A: In the 21st century, medical science will undergo more incredible and huge revolutionary changes, information technology, chip technology, and space and maritime technology will be more widely applied to life sciences, medical robotics, computer-assisted surgery, tissue engineering, nanotechnology and transgenic technology will be applied to the field of congenital surgery, which will have an immeasurable impact, by then, the selection criteria for the timing of surgery will again change dramatically. Many surgeries that are currently considered difficult will become routine procedures. The development of cloning technology will lead to incredible developments in tissue replacement, especially heart transplantation. Hopefully, in the near future, we will be able to save more children with precocious heart disease so that they can all grow up as healthy as normal children.